Tissue resectors with cutting wires, hand operated tissue resecting systems and associated methods

ABSTRACT

A tissue resector includes an outer cannula with a cutting wire disposed therein. The outer cannula includes an opening that is configured to be associated with a cutting element of the cutting wire in such a way that when tissue is drawn into the opening of the cannula, a cutting element of the cutting wire can be rotated past the opening to engage and cut into and through the tissue. The outer cannula and the cutting wire may also be configured to enable aspiration of the tissue. A tissue resector according to this disclosure may be used with a hand-held, hand-operated rooter.

CROSS-REFERENCE TO RELATED APPLICATION

A claim to the benefit of the Apr. 28, 2014 filing date of U.S.Provisional Patent Application No. 61/985,283, and titled MORCELLATORSWITH CUTTING WIRES, HAND-OPERATED MORCELLATION SYSTEMS AND ASSOCIATEDMETHODS (“the '283 Provisional Application”) is hereby made pursuant to35 U.S.C. §119(e). The entire disclosure of the '283 ProvisionalApplication is hereby incorporated by reference.

TECHNICAL FIELD

This disclosure relates generally to tissue resectors and, morespecifically, to tissue resectors that efficiently aspirate excisedtissue. In particular, tissue resectors that employ wires to removeundesired tissue, such as polyps and fibroids, are disclosed. Systemsand methods for resecting tissue are also disclosed.

RELATED ART

Morcellation is a process by which undesirable growths, such as benigntumors, polyps and fibroids, are removed from within a subject's body.Physicians have used morcellation in gynecological surgeries. Forexample, high powered electric morcellators have been used tolaparoscopically extract the uterus (i.e., hysterectomy). Specifically,an electric morcellator grinds the entire uterus, including anyundiagnosed sarcomas. While the risk is relatively small that thesecancerous tissues remain within a woman's body, there is a significantlikelihood that any cancerous cells that remain within the body mayspread.

In less invasive procedures, smaller morcellators have been used inconjunction with hysteroscopes to remove relatively small uterine polyps(e.g., polyps with diameters of about 3 cm or less, etc.) and fibroids(which typically have diameters of about 1 cm to about 2 cm). Somehysteroscopes are configured to inflate the uterine cavity with fluid orair. With the uterine cavity inflated, a light source of thehysteroscope may illuminate the interior surfaces of the uterus, and acamera of the hysterscope and a display associated with the camera ofthe hysteroscope may enable a physician to visualize features, such aspolyps and fibroids, on interior surfaces of the uterus. While thephysician is looking at the interior surface of the uterine wall, he orshe may operate a morcellator in conjunction with the hysteroscope toremove any polyps or fibroids that appear on the display. Debris fromthe morcellation process may be aspirated through the morcellator, andcollected for pathology.

The morcellators that are currently used to remove uterine polyps andfibroids are power-driven devices. A typical morcellator includes anouter cannula with an opening located near its distal end and formed ina portion of the circumference of the outer cannula. An inner cannula ispositioned within a lumen of the outer cannula, and includes a distalend that defines and blade that communicates with the opening near thedistal end of the outer cannula. Depending upon the configurations ofthe opening and the blade, the inner cannula may rotate within the lumenof the outer cannula, or the inner cannula may move longitudinally backand forth within the outer cannula. In any configuration, a polyp orfibroid may be drawn into the opening in the outer cannula, and then cutwith the blade of the inner cannula. Once the polyp or fibroid, or aportion thereof, has been cut from the inner surface of the uterus, itmay be drawn, by way of a vacuum, through a lumen in the inner cannula.

One example of an existing morcellator is the TRUCLEAR® morcellatoroffered by Smith & Nephew. That morcellator includes an outer cannulathat has an outer diameter of 0.114 inch (i.e., a cross-sectional areaof 0.0102 in²) and an inner cannula with an inner diameter of about0.070 inch (i.e., a cross-sectional area of 0.00385 in²). Thus, theavailable, open cross-sectional area through that device only comprises37.7% of the overall cross-sectional area occupied by the cannula ofthat device.

Hysteroscopy and morcellation can be painful. The relatively small innerdiameters of the inner cannulas of existing morcellators limit the rateat which excised tissues (e.g., polyps, fibroids, etc.) may becollected, which unfortunately and undesirably prolongs the morcellationprocedure and the pain caused by that procedure.

SUMMARY

A tissue resector according to this disclosure includes a cannula and acutting wire. The cannula has a lumen within which the cutting wire maybe positioned. The cannula includes an opening located at or adjacent toits distal end. The opening may be configured to receive uterine polypsand fibroids. A cutting feature at or near a distal end of the cuttingwire cooperates with the opening of the cannula in such a way that thecutting feature will cut, slice, shear, chew or tear tissue that isintroduced (e.g., by suction, etc.) into the opening. For the sake ofsimplicity, the acts of cutting, slicing, shearing, chewing, tearing andsimilar actions are individually and collectively referred to herein as“cutting.” The use of a cutting wire within a single cannula providesfor a relatively large cross-sectional area through which tissue may beaspirated through the cannula.

In various embodiments, of the entire cross-sectional area occupied bythe cannula, at least 50% may be available for aspiration. In someembodiments (e.g., embodiments where smaller cutting wires are used,etc.), the open area may comprise 60% or even 70% of the entirecross-sectional area occupied by the cannula.

In another aspect of this disclosure, a tissue resector according tothis disclosure may be part of a tissue resector system. In someembodiments, the tissue resector may be used with a rooter that operatesunder manual power, such as that disclosed by U.S. Patent ApplicationPublication No. U.S. 2012/0239008 of Fojtik, the entire disclosure ofwhich is hereby incorporated herein. Such a rooter is also referred toherein as a “hand-powered rooter” and as a “manual spinning instrument.”In other embodiments, the tissue resector may be used with apower-driven instrument, such as those used to drive the inner cannulasof existing morcellators, and an appropriate adapter, which translatesactions of the power-driven instrument to the features of a tissueresector with a single cannula and a cutting wire.

Another embodiment of tissue resector system includes an existingresector blade (with an outer cannula and an inner cannula on which ablade is defined), a hand-operated rooter and an adapter for convertingactions of the rooter to the features of existing resector blade.

As an example of use, a tissue resector or tissue resector systemaccording to this disclosure may be used to remove undesired growthsfrom a woman's uterus, including, without limitation, polyps, fibroidsand other undesirable growths. While viewing such a growth, it may bedrawn into the opening of a cannula under suction (i.e., a vacuum)applied to the lumen of the cannula. With the tissue in the opening, thecutting wire may be rotated, and its cutting feature may cut tissue fromthe growth. This process may continue until the growth and immediatelyadjacent tissues have been removed. The tissues, which are aspirated,may then be collected and evaluated by a pathologist.

Other aspects, as well as features and advantages of various aspects, ofthe disclosed subject matter will become apparent to those of ordinaryskill in the art through consideration of the ensuing description, theaccompanying drawings and the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings:

FIGS. 1A and 1B depict an embodiment of a tissue resector that includesa cannula and a cutting wire within a lumen of the cannula;

FIGS. 2A through 2H depict various embodiments of distal ends of andopenings of the cannulas of various embodiments of tissue resectors thatincorporate the features shown in FIGS. 1A and 1B;

FIGS. 3A and 3B illustrate some embodiments of cannulas that include twoor more openings;

FIGS. 4A through 4G show some embodiments of cutting wires that may beused with a tissue resector, such as that depicted by FIGS. 1A and 1B;

FIGS. 5A through 5C illustrate an embodiment of a tissue resector systemthat includes a tissue resector of the type shown in FIGS. 1A and 1B, aswell as a hand-powered rooter, with FIG. 5A illustrating the tissueresector system in an assembled state, FIG. 5B providing an explodedview of the elements of the hand-powered rooter and the tissue resectorand FIG. 5C providing a cross-sectional representation of the tissueresector system;

FIGS. 6A and 6B show an embodiment of an adapter for enabling use ahand-powered rooter with an existing morcellator, as well as anembodiment of a tissue resector system that includes the hand-poweredrooter, the adapter and the morcellator; and

FIG. 7 depicts an embodiment of an adapter for enabling use of a tissueresector of the type illustrated by FIGS. 1A and 1B with a power-driveinstrument of a conventional morcellation device, as well as anembodiment of a tissue resector system including the power-driveinstrument, the adapter and the morcellator.

DETAILED DESCRIPTION

As shown in FIGS. 1A and 1B, a tissue resector 10 according to thisdisclosure includes a cannula 20 and a cutting wire 30. The cannula 20is an elongated tubular element with a wall 22 that defines a lumen 24along its length. In the illustrated embodiment, the cannula 20 issubstantially straight; however, a tissue resector 10 according to thisdisclosure may include a curved cannula 20 or even a bent cannula 20.

The cannula 20 of a tissue resector 10 may have any of a variety ofdifferent dimensions. Without limitation, a cannula 20 may have an outerdiameter of about 5 French (i.e., 0.066 inch; 1.67 mm), about 7 French(i.e., 0.092 inch; 2.33 mm) or about 9 French (i.e., 0.118 inch; 3 mm),which may correspond to the size of a hysteroscope (e.g., to the size ofan access lumen through the hysteroscope, etc.) with which the tissueresector 10 is to be used. In a specific embodiment, the cannula 20 maycomprise a hypotube with an outer diameter of 0.115 inch and an innerdiameter of 0.095 inch.

At or near its distal end 26, the cannula 20 includes an opening 27. Theopening 27 is configured to receive undesirable growths, such as uterinepolyps and fibroids. In some embodiments, the edges 23 of the outer wall22 that define the opening 27 may be configured to facilitate separationof unwanted tissue from adjacent (e.g., healthy) tissue.

FIGS. 2A through 2H illustrate various embodiments of openings 27 in thecannula 20 or a tissue resector 10.

The cannula 20′ depicted by FIG. 2A includes an opening 27′ through itswall 22′ and positioned proximal to the distal end 26′ of the cannula20′. This configuration retains the tubularity of distal-most portion ofthe cannula 20′, which may hold a distal end of a cutting wire 30 (FIGS.1A and 1B) in place as the cutting wire 30 is rotated within the lumen24′ of the cannula 20′. The opening 27′ has a width that is about thesame as a diameter of the cannula 20′, and is at least partially definedby edges 23′ that are oriented longitudinally relative to the length ofthe cannula 20′. The opening 27′ is elongated, with its length beingoriented along the length of the cannula 20′.

FIG. 2B depicts an embodiment of a cannula 20″ that includes an opening27″ with a position and a configuration similar to those of the opening27′ of the embodiment of cannula 20′ depicted by FIG. 2A. However, theedges 23″ that define the periphery of the opening 27″ are configured asblades, with sharper edges adjacent to an interior surface 25″ of thelumen 24″ than the corresponding edges 23′ that define the opening 27′of cannula 20′. Thus, the edges 23″ that define the opening 27″ may cutinto tissue as a cutting wire 30 (FIGS. 1A and 1B) rotates within thelumen 24″ that extends through the cannula 20″.

Another similarly positioned and configured opening 27″′ is depicted byFIG. 2C, but with edges 23″′ that include teeth 23 _(T). The teeth 23_(T) may be configured to cut into tissue as a cutting wire 30 (FIGS. 1Aand 1B) rotates within the lumen 24″′ that extends through the cannula20″′.

The cannula 20″″ depicted by FIG. 2D includes an opening 27″″0 withedges 23″″ that comprise serrations 23 _(S). Accordingly, each edge 23″″may include a series of short, curved sections that are adjoined atteeth 23 _(T)″″.

The embodiment of tissue resector 10″″′ illustrated by FIG. 2E includesa cannula 20″″′ with an opening 27″″′ that is at least partially definedby edges 23″″′ that are oriented oblique to the length, or longitudinalaxis, of the cannula 20″″′.

In FIG. 2F, an embodiment of tissue resector 110 is shown with anopening 127 that extends to the distal end 126 of the cannula 120. Inthat embodiment, the portion of the distal end 126 that remains isclosed. Such a configuration may be used with a cutting wire 30′ thathas a cutting loop 37′ at its distal end 36′, and may at least partiallyhold the distal end 36′ in place as the cutting wire 30′ rotates. Theedges 123 that define the opening 127 may have any configuration,including, but not limited to, a substantially square configuration, orany of the configurations shown in and described in reference to FIGS.2B through 2E.

The embodiment of tissue resector 110′ shown in FIG. 2G includes acannula 120′ with an opening 127′ similar in configuration to theopening 127 of the embodiment of cannula 120 depicted by FIG. 2E;however, the entire distal end 126′ of the cannula 120′ is open. Theedges 123′ that define the opening 127′ may have any configuration,including, but not limited to, a substantially square configuration, orany of the configurations shown in and described in reference to FIGS.2B through 2E.

In the embodiment of tissue resector 210 depicted by FIG. 2H, thecannula 220 includes an open distal end 226, but no opening that extendsinto any portion of the circumference (i.e., the wall 222) of thecannula 220. The distal end 36′ of a cutting wire 30′, which may beconfigured (e.g., with a loop, etc.) to cut or otherwise separatetissues that are drawn into or otherwise come into contact with thedistal end 226 of the cannula 220, may protrude distally beyond thedistal end 226 of the cannula 220.

In some embodiments, such as those depicted by FIGS. 3A and 3B, thecannula 320, 320′ of a tissue resector 310, 310′ may include at leastone additional opening 328, 328′. Such an opening 328, 328′ may tailorthe manner in which debris is aspirated through the lumen 324, 324′ ofthe cannula 320, 320′ (e.g., by balancing suction, etc.), or it mayprovide another location (i.e., in addition to the opening 327, 327′located closer to the distal end 326, 326′ of the cannula 320, 320′) atwhich an undesired growth, such as a uterine polyp or fibroid, may beengaged, severed and aspirated by the tissue resector 310, 310′. In theembodiment depicted by FIG. 3A, the opening 328 is longitudinallyaligned with and located proximal to the opening 327, but is smallerthan the opening 327. FIG. 3B shows an embodiment in which the openings327 and 328 are located on different sides, or at different locationsaround the circumference, of the cannula 320.

While FIGS. 2A through 2F respectively show embodiments of cannulas withopenings that are that are at least partially defined by edges that arelinear or substantially linear, and, with the exception of theembodiment depicted by FIG. 2D, are oriented substantially parallel tothe lengths of their respective cannulas, the edges that define theopenings through the illustrated cannulas or any other embodiments ofcannulas may be curved, may include curved sections and/or may beoriented at oblique angles to their respective cannulas.

With returned reference to FIGS. 1A and 1B, the cutting wire 30 of atissue resector 10 may comprise a guide wire of a known type andconfiguration. Without limitation, the cutting wire 30 may comprise orconsist of a solid filament. Alternatively, the cutting wire 30 mayinclude a coiled filament, which may surround a solid filament. Asanother alternative, the cutting wire 30 may include features thatfacilitate engagement and/or cutting of tissue, such as grooves or teeththat engage tissue or teeth or a sharpened edge that cuts into tissue.In still another alternative, the cutting wire 30 may include proximalfeatures (e.g., helical grooves, teeth, a helical thread, etc.) thatfacilitate the proximal movement of tissues through the lumen 24 of thecannula 20 of a tissue resector 10, for example, by breaking downtissues and other materials as they move proximally through the lumen24, by forcing larger pieces proximally through the lumen 24 or by anyother suitable mechanism.

FIGS. 4A through 4F depict a few non-limiting embodiments of cuttingwires 30 that may be used in a tissue resector 10 (FIGS. 1A and 1B)according to this disclosure.

In FIG. 4A, an embodiment of a cutting wire 30′ is illustrated that issubstantially linear along a majority of its length, with a cutting loop37′ at its distal end 36′. The cutting loop 37′ of the cutting wire 30′may be elongated. The length of the cutting loop 37′ may be about thesame as or exceed the length of an opening 27 (FIGS. 1A and 1B) of acannula 20 (FIGS. 1A and 1B) with which the cutting wire 30′ is used.The width of the cutting loop 37′ may be the same as, substantially thesame as or less than the inner diameter of the lumen 24 (FIGS. 1A and1B) of a cannula 20 (FIGS. 1A and 1B) with which the cutting wire 30′ isconfigured for use.

In use, both sides of an open cutting loop, such as the embodiment ofcutting loop 37′ depicted by FIG. 4A, may cut into and through tissue.Thus, a cutting wire 30 with an open cutting loop (e.g., cutting loop37′, etc.) may cut tissue twice with each rotation.

FIG. 4B illustrates an embodiment of cutting wire 30″ with a twistedcutting loop 37″. As shown, a twisted cutting loop 37″ may have a singletwist, imparting it with a configuration that resembles athree-dimensional figure eight. Of course, a cutting loop 37″ may havefewer than one twist or it may include more than one twist. The diameterof a twisted loop 37″ may be the same as, substantially the same as orless than the inner diameter of the lumen 24 (FIGS. 1A and 1B) of acannula 20 (FIGS. 1A and 1B) with which the cutting wire 30″ isconfigured for use. A twisted cutting loop 37″ may comprise an openloop, or it may comprise a solid, flat element having a helicalconfiguration.

As another option, a cutting wire 30″′ may have a cutting feature 37″′formed in its distal end 36″′, as illustrated by FIG. 4C. The cuttingfeature 37″′ may comprise one or more sharp points, edges, indentationsor other features that may enable it to engage and cut tissue.

Another embodiment of cutting wire 130 is shown in FIG. 4D. That cuttingwire 130 includes a cutting element 137 located near its distal end 136.The cutting element 137 comprises an elongated region of the cuttingwire 130 that is offset from a remainder of the length of the cuttingwire 130. The distance of the offset may be the same as, substantiallythe same as, or less than the radius of a lumen 24 (FIGS. 1A and 1B) ofa cannula 20 (FIGS. 1A and 1B) within which the cutting wire 130 isconfigured to be positioned. The distal end 136 of such a cutting wire130 may be configured to facilitate smooth rotation of the cuttingelement 137 relative to an opening 27 (FIGS. 1A and 1B) through a wall22 of the cannula 20 with which the cutting wire 130 is configured to beused. In the depicted embodiment, the distal end 136 of the cutting wire130 is configured complementary to the distal end 26 (FIGS. 1A and 1B)of the cannula 20.

FIG. 4E illustrates an embodiment of cutting wire 230 with a centeringfeature 239 along at least a portion of its length, at a locationproximal to a cutting element (not shown) of the cutting wire 230. Theillustrated embodiment of centering feature 239, or any equivalentlyconfigured centering feature 239, may align an axis of rotation (notshown) of the cutting feature (not shown) with a longitudinal axisthrough the center of the lumen 24 (FIGS. 1A and 1B) of a cannula 20(FIGS. 1A and 1B) with which the cutting wire 230 is to be used. Such aconfiguration may optimize the stability with which the cutting wire 230rotates, providing for smooth rotation of the cutting wire 230 withinthe lumen 24 of the cannula 20.

Another embodiment of cutting wire 330 is shown in FIG. 4F. That cuttingwire 330 includes augers 339 along at least a portion of its length. Theaugers 339 may be configured and oriented to facilitate the flow ofexcised tissue proximally through the lumen 24 (FIGS. 1A and 1B) of acannula 20 (FIGS. 1A and 1B) with which the cutting wire 330 is used. Insome embodiments, at least some of the augers 339 may be configuredand/or oriented to break the excised tissue into smaller pieces, furtherfacilitating the rate at which they may flow proximally through thelumen 24 of the cannula 20. In some embodiments may comprise discreteelements. In other embodiments, the augers 339 may have helicalconfigurations, which may comprise one or more Archimedes screwspositioned along the length of the cutting wire 330.

FIG. 4G illustrates an embodiment of cutting wire 430 that includes asolid, elongated element 431 with a flattened distal end 432 and acutter 435 secured to the flattened distal end 431. The cutter 435 maycomprise a cylindrical element with an open proximal end 436, into whichthe flattened distal end 431 of the elongated element extends. A distalend 437 of the cutter 435 may also be open (e.g., to enable samplesand/or debris to be aspirated therein, etc.). The cutter 435 may alsoinclude one or more features that may cooperate with an opening 27through a cannula 20 (see, e.g., FIG. 1B). In the illustratedembodiment, a slot 438 extends along a portion of a length of the cutter435, with opposed edges 439 of the slot 438 being configured to cut intobody tissue or other materials as the cutting wire 430 is rotated withina lumen 21 of a cannula 20. In some embodiments, the edges 439 maycomprise blades, teeth or serrations or other features that enable themto cut readily into and through body tissue or other materials.

Returning reference again to FIGS. 1A and 1B, the cutting wire 30 of atissue resector 10 may be of any suitable size (e.g., have an outerdiameter) that will cut tissue in the desired manner while enabling thetissue to be aspirated through the lumen 24 of the cannula 20 at anacceptable rate (e.g., at a rate that will minimize the duration of atissue resection procedure and, thus, the pain suffered by a patient,etc.). As an example, acceptable rates of aspiration may be achievedwith a tissue resector 10 that has a lumen 24 with an opencross-sectional area (i.e., the cross-sectional area of the lumen 24minus the cross-sectional area of the cutting wire 30) that is at least50% of the cross-sectional area of the cannula 20. In a specificembodiment, a cannula 20 with an outer diameter of 0.115 inch (i.e., across-sectional area of 0.0104 in²) and an inner diameter of 0.095 inch(i.e., a cross-sectional area of 0.00709 in²), when used with a 0.040inch (i.e., 0.00126 in² in cross-sectional area) cutting wire 30, willhave an open cross-sectional area of 0.00583 in², which accounts for56.1% of the entire cross-sectional area occupied by the cannula 20. Ofcourse, the use of smaller cutting wires 30 would provide an even largerpercentage of open area (e.g., at least 60%, at least 65%, at least 70%,etc.) and enable even greater rates of aspiration.

As illustrated by FIGS. 5A through 5C, a tissue resector 10 according tothis disclosure may be operated under manual power (i.e., by hand) witha rooter 50, such as that described by U.S. Patent ApplicationPublication No. U.S. 2012/0239008 of Fojtik. Together, the tissueresector 10 and the rooter 50 may provide a tissue resector system 1.Such a rooter 50 may easily be used to rotate a cutting wire 30 at about500 revolutions per minute (rpm), and can generate up to about 3,000rpm, which may result in about 1,000 cuts per minute and 6,000 cuts perminute, respectively.

The rooter 50 of a tissue resector system 1 may enable rotation of acutting wire 30 of the tissue resector 10 as the cannula 20 of thetissue resector 10 is held substantially stationary. As the rooter 50 ismanually operated, it may spin the cutting wire 30 in a repetitiousback-and-forth (i.e., clockwise and counterclockwise) manner, which mayprovide for two sets of cutting wire 30 rotations with each pull (orpush) on an actuator of the rooter 50.

When an embodiment of cutting wire 30′ (FIG. 4A) having an open cuttingloop 37′ (FIG. 4A) is used in the tissue resector system 1, since thecutting loop 37′ cuts tissue twice with each rotation of the cuttingwire 30′, manual operation of the rooter 50 and, thus, hand-operatedrotation of the cutting wire 30′ may efficiently cut tissue and, thusremove the same from an individual's body.

Turning now to FIGS. 6A and 6B, with a proper adapter 60, a rooter 50that is configured for hand-powered operation may also be used with thelimited use (e.g. disposable, etc.) portion 70 of a conventionalmorcellator, providing another embodiment of tissue resector system 1′.

The depicted embodiment of adapter 60 includes a series of elements thattranslate the action generated by the rooter 50 to an action thatrotates the inner cannula, or blade 72, of a conventional morcellator.More specifically, the adapter 60 may include elements 61 and 62 thatare respectively configured to engage a rotatable element of the rooter50 and a proximal end 73 of the blade 72. Element 62, which isconfigured to engage the proximal end 73 of the blade 72, may beconfigured to rotate the blade 72 about an eccentric axis (e.g., an axisthat enables the blade 72 to move rotational over an inner circumferenceof a lumen 74 of an outer cannula 76, etc.).

In addition, the adapter 60 may include one or more stationary elements63 and/or a distal end cap 66 that may be configured to hold the outercannula 76 that surrounds the blade 72 stationary, even while the blade72 is rotated within a lumen 74 of the outer cannula 76.

In addition, the adapter 60 may include seals 67, 68, which enablemovement of the blade 72 within the lumen 74 of the outer cannula 76.while simultaneously enabling the aspiration of body tissues, fluids orthe like through the lumen 74 of the outer cannula 76, through thehousing 65 of the adapter 60 and through an aspiration port 64 thatcommunicates with an interior of the housing 65 of the adapter 60. Thus,the seals 67, 68 enable a suction (i.e., a vacuum) to be applied to theaspiration port 64 and communicated through the housing 65 of theadapter to the lumen 74 of the outer cannula 76 to drawn tissue, fluidor other materials proximally therethrough.

As depicted by FIG. 7, in another embodiment of tissue resector system1″, a tissue resector 10 may also be used with a power-drive instrument90 of a conventional morcellator when coupled to the power-driveinstrument 90 with an appropriately configured adapter 80. The adapter80 may be configured to translate rotating action by the power-driveinstrument 90 to the cutting wire 30 (FIGS. 1A and 1B) of the tissueresector 10 and convert a system that aspirates through the power-driveinstrument 90 for communication with the lumen 24 (FIGS. 1A and 1B) thatextends through the outer cannula 20 (FIGS. 1A and 1B) of the tissueresector 10.

Although the foregoing disclosure provides many specifics, these shouldnot be construed as limiting the scope of any of the ensuing claims.Other embodiments may be devised which do not depart from the scopes ofthe claims. Features from different embodiments may be employed incombination. The scope of each claim is, therefore, indicated andlimited only by its plain language and the full scope of available legalequivalents to its elements.

What is claimed:
 1. A tissue resector, comprising: a cannula including:a wall; a lumen defined through the wall and extending along a length ofthe cannula; a distal end; and an opening at or adjacent to the distalend and establishing communication between an exterior of the wall andthe lumen; and a cutting wire within the lumen, the cutting wireincluding: a cutting feature that cooperates with the opening throughthe cannula.
 2. The tissue resector of claim 1, wherein an opencross-sectional area including a cross-sectional area of the lumen lessa cross-sectional area of the cutting wire comprises at least 50% of thecross-sectional area of the cannula.
 3. The tissue resector of claim 2,wherein the open cross-sectional area comprises at least 60% of thecross-sectional area of the cannula.
 4. The tissue resector of claim 2,wherein the open cross-sectional area comprises at least 70% of thecross-sectional area of the cannula.
 5. The tissue resector of claim 2,wherein an outer diameter of the cannula is about 0.115 inch and adiameter of the lumen is about 0.095 inch.
 6. The tissue resector ofclaim 5, wherein the cutting wire has an outer diameter of about 0.040inch or less.
 7. The tissue resector of claim 1, wherein the opening ofthe cannula is defined through a circumference of the cannula.
 8. Thetissue resector of claim 7, wherein the opening of the cannula is spacedproximally from the distal end of the cannula.
 9. The tissue resector ofclaim 7, wherein the opening of the cannula extends to the distal end ofthe cannula.
 10. The tissue resector of claim 1, wherein the opening ofthe cannula is defined through the distal end of the cannula.
 11. Thetissue resector of claim 1, wherein the cannula further includes: atleast one secondary opening through the wall of the cannula and locatedproximal to the opening.
 12. The tissue resector of claim 1, wherein theopening of the cannula includes at least one edge configured to cut intotissue.
 13. The tissue resector of claim 1, wherein the cutting featureof the cutting wire includes at least one edge configured to cut intotissue.
 14. The tissue resector of claim 1, wherein the cutting featureof the cutting wire includes at least one element offset from arotational axis of the cutting wire.
 15. The tissue resector of claim14, wherein the cutting feature comprises a loop.
 16. The tissueresector of claim 15, wherein the loop comprises an open loop.
 17. Thetissue resector of claim 15, wherein the loop comprises an elongatedloop.
 18. The tissue resector of claim 17, wherein the elongated loopcomprises a twisted loop.
 19. A tissue resection system, comprising: atissue resector according to claim 1; and a hand-powered rooter forrotating the cutting wire of the tissue resector.
 20. A tissue resectionsystem, comprising: a tissue resector blade; a hand-powered rooter; andan adapter for translation an action of the hand-powered rooter to aninner cannula of the tissue resector blade.
 21. A tissue resectorsystem, comprising: a tissue resector according to claim 1; apower-driven instrument; and an adapter for translating an action of thepower-driven instrument to the cutting wire of the tissue resector torotate the cutting wire.
 22. A method for removing tissue from a body ofa subject, comprising: drawing tissue into an opening of a tissueresector; rotating a cutting wire of the tissue resector to cut thetissue; and aspirating cut tissue.
 23. The method of claim 22, furthercomprising: repeating the acts of drawing, rotating and aspirating.